Ohio Medicaid’s Full Response to the Auditor of the State Report Regarding Potential Concurrent Enrollment
By Department of Medicaid / March 26, 2024
Ohio Medicaid’s Full Response to the Auditor of the State Report
Regarding Potential Concurrent Enrollment
The Ohio Department of Medicaid (ODM) serves more than 3 million people and takes seriously its responsibility to Ohioans. From incentivizing care quality and revamping care delivery to fighting fraud and bolstering program integrity, we are committed to serving Ohio's individuals, families and taxpayers. Since the start of this administration, the department has made great strides in improving the integrity of its program and connecting families and communities with the healthcare they need.
While the department appreciates the continued work of the Auditor of the State, we are unable to validate the audit report’s conclusions and have questions about the audit’s methodology. The entirety of the response is accessible here. Our concerns include:
The auditor’s report states that Ohio “spent more than $1 billion in (managed care) payments for the 124,000 individuals” in the sample, yet also indicates that “Ohio’s potential impact is $209 million.” Neither figure can be considered accurate or reliable, as the report does not take into consideration the assessment required of ODM to determine how managed care rates are actually calculated.
The auditor’s report covered 48 months, nearly three-fourths (34) of those months occurred during the COVID-19 public health emergency. During this time, heightened federal requirements were put in place that prohibited states from removing otherwise ineligible people from Medicaid, requirements that the AOS report fails to adequately consider. Despite changing regulations from the federal government throughout the PHE, Ohio maintained compliance, securing more than $4 billion dollars in additional federal funds.
ODM inherited a 43.9% eligibility error rate in 2019 and has worked to dramatically improve the rate to 8.23% in reporting year 2022 as process improvements are continuing.
The auditor’s report used a sample of Medicaid members who were concurrently enrolled in Ohio and another state(s) for three months. Despite requests from the department, the auditor’s office did not provide the sample and other specifics regarding the methodology. Without this basic information, ODM was unable to test or validate the audit.